HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 1 LT 8Abbot Loop
Manor
Block 1
Lot 8
#014-181-08
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4.i f
4700 Elmore Road
x.'
t F.O. Box 196650
Mark BeB ich Anchorage, AK 99507 $ A £ } Y
Mayor www muni org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Propert Owner Name & Address:
AS IS V ),0010 M19t�"o �a6Ci2tcksi
�Syl t2)o 6e�lnvC 6(4-
P — /
(4-P—I L - S? 11 ('705f ;Ak
Pump Installation Date: 9—y -/S
Pump Intake Depth Below Top of Well Casing: i (a feet
Pump Manufacturer's Name: (2F I) SoCKr
Pump Model: jUC_jll SS12.
Pump Size NIahp
Pitless Adapter Burial Depth: j feet
Pitless Adapter Manufacturer's Name: MOSS
Pitless Adapter Installer:
Well Disinfected Upon Completion? M Yes [j No
Method of Disinfection: P, Yj 1=R 11 F'S
C( LG
Comments:
Pump Installer Name: 4k e_�
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
CHUGIAK, AK
688-3199
WE SERVE
qi'~*;RILLING CO. ~
P.O. BOX 670042 -- CHUGIAK, ALASKA $9567
ALLALASKA
WASILLA, AK
376-3199
WELL-SIT.~d.~...~..~...~..~h~..~0. P....H~.~.~..~b_'~. ..........
DATE-STARTED....~Z~..~ ..........................................................
DATE-ENDED ........ .?.E~§~ ....................................................................
st^nc LEVEL OF WATER FT...?.Z.[~.: .................................................
DMw OOWN FT...½.{L.{!: .................... : ................................................
GALS. PER HR.....3..0...0...f..t:.:.....1.;~.T.::. .........................................................
~o oF c~,N~....E.°....~:....°...LL~."..~-'..!S.~L~..~.L!~?-~i~.~l
KIND OF FORMATION:
F.~,, 0 ~ 2 ~Casino Stub. uu
FROM ................... ~. FT. zo .................. !. FT. ~£.Lb..?.~.~.~ ...........
FROM ........... :..2.~. Fr. zo .............. A§.. FT. ~.~...~.~ .........
FROM ................ 3g. FT. XO ................ ~....iT.g!!~...~..gr.~ ....
FnnM 94~r?n I10 ~r Coarse Sand-vet
I10 121 Sand Gravel ~acer
FROM ...................... FT.~O ...................... FT .............................. ~ ....
FROM ..................... FT. TO ...................... FT ...................................
FROM ...................... FT. TO ...................... FT ...................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ....................... FT. TO ....................... FT ..................................
FROM ....................... FT. TO ........................ FI' .................................
FROM ....................... FT. TO....~ .................. FT .................................
FROM ....................... FT. TO ....................... FT ................................
DF-.PT. OFHg~ &
FROM
FROM ...................... FT. TO .......................................
· FROM ....................... FT. TO ........................ FT .................................
FROM ...................... IT. TO ..................... FT .................................
FROM ....................... FT. TO ....................... FT .................................
MISCI. INFORMATION: l~o Warraury or no ~'arran~ie~ taupiied
Se~ punp ar 115 ft.
MUlti I I~ I F;~-~I_ I ]'Y 01--- AI~C.I-~DI~AE;E
DEPARIMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L SIREET, ANCHORAGE, At{ 99501
264-4720
OI~I--S I -rE WELL F'EI-~M I ]-
F'ERM I'l NO:
DATE 1SSUED:
860066
05/07/~36
AF'F'L 1QAN r: PROCESO V I LLANUEVA
ADDRESS: ~Z2~l MULDOON RD. ~861
ANCHORAGE, AK 99504
CUflIA~I . PI*tONE: ~57-4~64
LEGAL DEsCR1P: SUBDIVISION: ABBOI]' [OOP ~ANOR
SECIION: 8 'IOWNSHIP: 12N
LO~ SIZE: 1400[~ (SQ.FT. OR ACRES)
LOT: 8 BLOCK: 1
RANGE: 5W
1 certify that:
1. I am ~amiliar with
sewerage system on this ~r any adj~nt or nearby
the requirements for on-site sewers and wells as set
~orth by the Municipality o~ Anchorage (MOA} and the State ~ Alaska·
I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design c~'iteria of this permit.
1 will adhere to ail MOA and State o~ Alaska requirements For the set back
distances ~rom any existing well~ wastewater disposal system or public
lot.
APF'LICANI: F'ROCESO VILL. ANLI~VA
ISSUED E,Y ~__ ~ '~_~..~___. ~~__ DATE:
Municipality of Anchorage d
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 014-181-08 Expiration Date:
1. GENERAL INFORMATION
Complete legal description ABBOTiL00P MANOR S/D BLOCK 1 LOT 8
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
2541 RIO GRANDE ANCHORAGE, AK 99507
JUDY TRAVIS Day phone 227-7687
2541 RIO GRANDE ANCHORAGE, AK, 99507
KATHY FERNANDEZ W/ PRUDENTIAL Day phone
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 1
4. TYPE OF WATER SUPPLY:
441-9000
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
0
Received by: -1 `'r Date:
COSA to be released to the engineer, unless othervose requested by the engineer.
COSA Fee
Date of
Receipt Number
COSA# 13 13
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GRQUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD, attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being seared by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sale benefit of the owner listed above. Any reliance upon or use of this report by any
otherperson or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
M
Phone
337-6179
Date
OF
CE 3, eve
,pro f essiolno10
System #1 Approved for _ bedrooms. V V
System #2 Approved for bedrooms. �(tOF tC�
Disapproved. J ON-
SiTE
Conditional approval for bedrooms, with the following stipulations: =g WATER AND
WASTEWATER
Original Certificate Date: /0 -,qg--/3
The Whici#a/it)VorA&Ihorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS: /
COSA Checklist v Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: ABBOTT LOOP MANOR S/D; BLOCK 1, LOT 8 ParcellD: 014-181-08
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 7/7/1986 Sanitary seal (Y/N) Vq 5 Wires properly protected (Y/N) YES
Total depth 121 ft. Cased to 120 ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Date of test 7/7/1986
Static water level ao ft.
Well production 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform t L r '0 colonies/100 ml.
��
Arsenic: ✓ ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
AT INSPECTION
7/1/2013
54 ft,
3.5+ g.p.m.
Nitrate L0_mg./L. Collected by: GEG, Ltd.
Date of sample: 10/18/2013
PUBLIC SEWER
Date installed
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) _ Depression over tank (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth ft. Eff.
Date of adequacy test
Pumper.
Soil rating (g.p.d./ft or
Width i
Cleanouts(Y/N)
High water alarm
ft Monitoring tube
Results (Pass/Fail)
System type
Gravel below pipe ft.
Depression over field
For bedrooms
Fluid depth in absor n field before test in. Water added _gal. New depth _in.
Elapsed Ti _min. Final fluid depth _ in. Absorption rate >= g.p.d.
y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at wa er alarm level at in.
Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots N/A
Absorption field on lot N/A On adjacent lots N/A
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation
Water main
Wells on adjacent lots
Property line Absorption
Water service line Surface w
SEPARATION DISTANCE FROM ABSORPTION
Property line .
Water service
F. COMMENTS
G. ENGINEER'S CERTIFICATION
TO:
Water
Surface water Driveway, parking/vehicle storage
Wells on adjacent lots
-
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date /D/Z5.(3
(Rev. 11105)
Municipality of Anchorage
• "'
On -Site Water & Wastewater Program tt
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 014-181-08 Expiration Date: / J 3
1. GENERAL INFORMATION
Complete legal description ABBOT LOOP MANOR S/D; BLOCK 1, LOT 8
Location (site address) 2541 RIO GRANDE, ANCHORAGE, AK, 99507
Current Property owner(s) JUDY TRAVIS
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
Day phone
2541 RIO GRANDE, ANCHORAGE, AK, 99507
KATHY FERNANDEZ W/ PRUDENTIAL Day phone
N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
227-7687
441-9000
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $��O Waiver Fee $
i
Date of Payment 11511 _ Date of Payment
Receipt Number2 2�b r� Receipt Number
COSA # O`J C-1 :) V 3YKK Waiver #
TYPE OF WASTEWATER DISPOSAL:
7 ®
Individual On-site
L/
❑
Individual Holding tank
❑
Community site
❑
Public Sewer
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $��O Waiver Fee $
i
Date of Payment 11511 _ Date of Payment
Receipt Number2 2�b r� Receipt Number
COSA # O`J C-1 :) V 3YKK Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, i verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational ife of all wells and
septic systems depend on the beat sells condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
V System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
Phone
337-6179
Date 1'2 13
Original Certificate Date:
rANC�
ON-SITE ��
WATER AN[3
W\ZEWATER n^
)t
The MtJR(cipaFty6fAj6chbrage Develop, errt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11105)
ce Nitrate Advisory
Arsenic Advisory
Other
7.- X13
If more than 1 septic system is on the lot:
COSA Checklist # _of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: ABBOTT LOOP MANOR S/D; BLOCK 1, LOT 8 Parcel ID: 014-181-08
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSII,D# N/A Well Log (Y/N) YES
Date completed 7/7/1986 Sanitary seal (Y/N)tj/�s Wires properly protected (Y/N) YES
Total depth 121 ft. Cased to 120 ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Date of test 7/7/1986
Static water level ao ft.
Well production 5 g.p.m.
AT INSPECTION
7/1/2013
54 ft,
3.5+ g.p.m.
WATER SAMPLE RESULTS: e �/�
Coliform v colonies/100 ml. Nitrate/`-'r-� mg./L. Collected by: GEG, Ltd.
Arsenic: L2_oug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Date of sample: 7/1/2013
PUBLIC SEWER
Date installed
Tank size gal. Number of Compartments
Foundation cleanout (YIN) _ Depression over tank (YIN)
Date of pumping
C. ABSORPTION FIELD DATA
Pumper
Cleanouts(Y/N)
High water alarm
Date installed Soil rating (g.p.d./ftlor ft2/bdr System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption ea ft Monitoring tube_ Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor n field before test in. Water added _gal. New depth _in.
Elapsed Ti . —min. Final fluid depth _ in. Absorption rate >= g.p.d.
y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at wa er alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots N/A
Absorption field on lot N/A On adjacent lots N/A
Public sewer main
75'+
Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption
Water main
Wells on adjacent lots
Water service line Surface water.
SEPARATION DISTANCE FROM ABSORPTION FI
Prope:in
y line B ' oundation
Wateervice line Surface water
drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i certify that f have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date I )) 2- b
(Rev. 11/05)
TO:
Water
PUBLIC SEWER
Driveway, parking/vehicle storage
H
k
IV UTLrrY EASEMEIM \
(
LOT 9
141:3' ` z
s3.r
WELL
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O1. CARPORT wlti� f
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LOT 8 i
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f LOT 6
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PLOT PLAN — ASBUILT A SCALE I' --3W GRID 2M Project Na. ce'm
Lang cit Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
907 522-6476 Phone
Registered Land Surveyors 907 522-4625 Fax
I hemby csrWy that I have earveyed the following deaara" property: ......
LOT a ®LOCK t, ABBOW LOOP MANOR SUBDIVISION
Anchors Recording District. Alaska. and that the tmpmvements ouated
thwean ace wRhtn the property lines and do not enom ch oMo the *E�:` 49313
adlaoent Itmelw that no Improwm ants on the property tying adfacent iherets ,1l1 ..
soarvach on the surveyed paumiaee and ih m a taofission
lines Y. .. ..
or other vW* sasemeads on Bald as hs �.V G. ®:
Dated this the 21 Day of _ : 40JUX 4 ?Ao at Anchorage, Alaska LS -5202
It Is the remponsWilly of the owner to delarmhe the oseistence of my eco, ant% ••••
covenants, or reslrtaBone which do not appear on the recorded subdtrisian plat